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I'm Stuffed Up - What Should I Do?

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Dear COPD Coach,
I have a real problem bringing up mucous. The worst time seems to be in the morning. I have a couple questions: Is this common with COPD and what is the best way to get rid of the mucous?

-Stuffed Up

Dear Stuffed Up,

Mucous is indeed a problem for many who have COPD especially if you have a chronic bronchitis component with your COPD. It is also not uncommon to have a great deal of mucous in the morning. Oftentimes, the mucous will settle either high up in your lungs or seem to be blocking your airway. Until you are able to clear this mucous, your breathing will suffer and most often you will experience a lack of energy (as if anyone has a great deal of energy in the morning).

It is important to try and thin out the mucous in order to make it easier to bring up. If mucous is allowed to thicken it could form mucous plugs that may block off portions of your small airways. You should talk with your doctor about the possibility of using a product like Mucinex (which is available over the counter but can be prescribed in higher strength). Drinking lots of water throughout the day can also help thin out the mucous (always check with your health care provider before increasing fluid intake as it may affect your heart). A simple method some have found helpful is to drink something very cold followed by something very hot first thing in the morning to help loosen the mucous clog.

If you are like many folks with COPD, you may not have enough strength to cough up the mucous especially in the morning. If this is the case, there are a variety of mechanical assistance devices available to make mucous clearance a little easier with less effort on your part. These devices are divided into two categories: internal and external.

Stuffed Up Let’s start with external. The simplest and least costly devices are the “Lung Flute” or a relative newcomer called the Quake. The lung flute, like its name, looks like a small flute. Breathing through it causes vibrations in your airways that loosen secretions making them easier to cough up. The Quake works on much the same principal other than that the patient turns a small handle to vary the vibration. While these units can be effective, they do require some effort on the part of the patient in order to accomplish their task. Other devices are the Acapella and Flutter. Although it is best and most effective to sit upright to achieve the best cough effort, one advantage of the Acapella is that it can be used when lying down.

Other external options (though more costly) are percussion vests, which require less physical effort on the users part. These were first developed for people with cystic fibrosis, but soon became effective for use with COPD. The percussion vest looks much like a life vest connected to an air pump. The air generator rapidly fills and deflates the vest, compressing and releasing the chest wall, dislodging mucous moving it towards the central airway.

These units can be very effective, but are bulky (the vest attaches by hoses to a large air unit) and very expensive. They are covered by most insurances and Medicare with a physician’s order.

A new arrival on the market is the Aflo Vest produced by International Biophyphysics, which is a self contained unit with all the mechanics contained within the vest. It provides multiple levels of therapy, is powered by a rechargeable battery and is somewhat inexpensive. Because the device is self contained, you can actually walk from room to room while getting this therapy. It is also more easily transportable if you travel.

The Internal devices are often referred to as IPV (Intrapulmonary Percussive Ventilation). Instead of providing external percussions, the devices provide internal percussions directly within the airways.

The original IPV device was pioneered by Dr. Forest Bird (who developed the famous Baby Bird Respirator used with premature infants) and is manufactured by Percussionaire. In simplest terms, the unit involves breathing moisturized pressurized air pulses to loosen mucous throughout the entire airway to loosen mucous and expel retained carbon dioxide. The device is very effective, and comes in a portable unit the size of a large camera case. Other manufacturers have come up with variations of this device though they are not as portable. The AIRVO was recently introduced by Fisher Paykel. It provides 100% humidity at body temperature, breathed directly into the lungs to loosen secretions. The device is compact and is very effective and is covered by most insurance and Medicare. It does not use pulsating air like the other devices.

One more type of mucous clearance is based on a simple concept – using gravity to drain your lungs. This is called postural drainage, and although it isn’t an appropriate treatment for everybody, it does work well in select groups. Ask your respiratory health care professional if postural drainage might work for you.

All of these devices can be effective, and most require less work on the part of the user. The costs also vary, and some of the more expensive units might be prohibitive without insurance coverage. Personally, I carry either the Lung Flute or Quake while traveling due to portability and weight issues, but have extensively used and tested the other devices and have found them all to be effective to varying degrees, some with quicker results than others. I am sure there are other devices out there that I have not mentioned, and as I come across new devices, I will endeavor to bring them to the attention of our readers.

The important thing to take away from all of this is that mucous removal is VERY IMPORTANT! When you are able to clear your lungs of excess mucous, you will breathe better as well as lessen the chances of an exacerbation or lung infection. Even simple and inexpensive devices can be of help to many with mucous clearing problems, and whatever device works for you, it should be a regular part of your treatment.

-The COPD Coach

Ask the Expert is aimed at providing information for individuals with COPD to take to your doctor, and is not in any way intended to be medical advice. If you would like to submit a question to the Coaches Corner email us at coachescorner@copdfoundation.org. We would love to hear your questions and comments. You can address your emails to any of the following: COPD Coach, Caregiver Coach, COPD Doctor or COPD RT.

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  • 12 paragraphs, not 1 OTC medication recommendation. What about saying Robitussin, Claritin, etc. wow!
    Reply
    • Hello Equalizer,

      You have a valid point. There are some OTC meds that help with chest congestion.

      But others can be harmful when combined with prescription meds. This is why you should always ask your health care provider about OTC meds and not "go it alone." Also, some OTC meds that tend to dry up your mucus may cause your mucus to become thick and sticky - and difficult, or impossible, to cough out.

      Rule of thumb is to always ask your health care provider what OTC meds are safe to combine with your usual medications. If you are shopping for an OTC med and haven't checked with your HCP, ask the pharmacist on duty if they would be safe with your prescription meds.

      I hope this helps.

      Reply

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